Gregory L. Pugh, PhD, LICSW, ACSW

Hospital social workers' perceptions of ethical environment

Hospital social workers are in the unique position of being one of the only non-medical professions working in the hospital setting. This raises some interesting challenges in hospital social work practice, especially when it comes to professional ethics. The medical model of ethical reasoning is different from social work models, and the medical model contributes a great deal to the overall Ethical Environment in a hospital.

Ethical Environment is a new concept for hospitals to consider and has only recently been explored, almost exclusively with samples of nurses. That research suggests that a number of personal, professional, and organizational factors may influence perceptions of Ethical Environment, and that Ethical Environment has an impact on ethical practices and behavior. The hospital social work and ethics literature also suggests relationships between some of the same factors and the ethical practices and behaviors of social workers, but has not considered Ethical Environment. Both the nursing and social work literature suffer from a lack of large, representative samples.

This study was designed to explore the relationships between personal, professional, and organizational variables and perceptions of hospital Ethical Environment among social workers in a large, nationwide, representative sample. The study succeeded in collecting a sample of 973 social workers from 290 hospitals in a random closed population cluster sample across 40 US States. Participants completed an online survey questionnaire about the Ethical Environment of their hospitals, and resulted in hospital social workers rating the Ethical Environment significantly higher than nurses.

Significant predictors of the rating of Ethical Environment are based primarily on job satisfaction, with some contributions from years of service, attendance at hospital-based ethics education programs, and a centralized social work department configuration. Social workers also rate the environment of for-profit hospitals greater than non-profit hospitals. Results indicate that larger hospitals with greater resources directed at ethics provide the best Ethical Environment for social workers.

Professional social work ethics education and training was not predictive, which raises questions about the content and methods of teaching social work ethics.